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Preventing cardiovascular events in patients with diabetes mellitus

  • William T Abraham
    Correspondence
    Requests for reprints should be addressed to William T. Abraham, MD, Division of Cardiovascular Medicine, The Ohio State University, 473 West 12th Avenue, Room 110P DHLRI, Columbus, Ohio 43210-1252, USA
    Affiliations
    Division of Cardiovascular Medicine and the Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA
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      Abstract

      Diabetes mellitus and obesity are becoming increasingly prevalent in the United States. Patients with diabetes are 2 to 3 times more likely to develop cardiovascular disease (CVD) than are individuals without diabetes, but proper diabetes management and metabolic control can reduce this risk. Nonpharmacologic interventions, such as diet and exercise, can help to reduce weight and control insulin resistance, blood glucose levels, and lipid abnormalities, thereby lowering the risk of adverse cardiovascular outcomes. However, diet and exercise can provide particular challenges for the patient with diabetes. Antiobesity drugs, such as sibutramine and orlistat, can help individuals with diabetes lose weight and can have some effect on metabolic control. Alcohol use and hormone replacement therapy are still controversial topics with regard to reducing the risk of CVD. Smoking is known to be particularly dangerous for those with diabetes, and it is important for health care providers to help their patients stop smoking. Early and aggressive intervention in treating risk factors can reduce the risk of developing diabetes and prevent CVD in the patient with diabetes.
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      References

        • Mokdad A.H.
        • Ford E.S.
        • Bowman B.A.
        • et al.
        Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001.
        JAMA. 2003; 289: 76-79
      1. American Diabetes Association. The impact of diabetes. American Diabetes Association facts and figures. Available at: http://www.diabetes.org/main/info/facts/impact/default.jsp. Accessed June 18, 2003

        • Young L.R.
        • Nestle M.
        The contribution of expanding portion sizes to the US obesity epidemic.
        Am J Public Health. 2002; 92: 246-249
        • Nielsen S.J.
        • Popkin B.M.
        Patterns and trends in food portion sizes, 1977-1998.
        JAMA. 2003; 289: 450-453
        • Kannel W.B.
        • McGee D.L.
        Diabetes and cardiovascular disease.
        JAMA. 1979; 241: 2035-2038
      2. Geiss LS, Herman WH, Smith PJ. Mortality in non-insulin-dependent diabetes. In: National Diabetes Data Group, ed. Diabetes in America. 2nd ed. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 1995:233–258. NIH publication 95-1468

        • National Cholesterol Education Program
        Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III).
        JAMA. 2001; 285: 2486-2497
        • Turner R.C.
        • Millns H.
        • Neil H.A.
        • et al.
        Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus.
        BMJ. 1998; 316: 823-828
        • Eckel R.H.
        • Krauss R.M.
        American Heart Association call to action.
        Circulation. 1998; 97: 2099-2100
        • Gaede P.
        • Vedel P.
        • Larsen N.
        • et al.
        Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes.
        N Engl J Med. 2003; 348: 383-393
        • Cho E.
        • Manson J.E.
        • Stampfer M.J.
        • et al.
        A prospective study of obesity and risk of coronary heart disease among diabetic women.
        Diabetes Care. 2002; 25: 1142-1148
        • Chan J.M.
        • Rimm E.B.
        • Colditz G.A.
        • et al.
        Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men.
        Diabetes Care. 1994; 17: 961-969
        • Hu F.B.
        • Manson J.E.
        • Stampfer M.J.
        • et al.
        Diet, lifestyle, and the risk of type 2 diabetes mellitus in women.
        N Engl J Med. 2001; 345: 790-797
        • Franz M.J.
        • Bantle J.P.
        • Beebe C.A.
        • et al.
        Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications.
        Diabetes Care. 2002; 25: 148-198
        • Goldstein D.J.
        Beneficial health effects of modest weight loss.
        Int J Obes Relat Metab Disord. 1992; 16: 397-415
        • Banerji M.A.
        • Lebowitz J.
        • Chaiken R.L.
        • et al.
        Relationship of visceral adipose tissue and glucose disposal is independent of sex in black NIDDM subjects.
        Am J Physiol. 1997; 273: E425-E432
        • Lean M.E.
        • Powrie J.K.
        • Anderson A.S.
        • Garthwaite P.H.
        Obesity, weight loss and prognosis in type 2 diabetes.
        Diabet Med. 1990; 7: 228-233
        • Zeller K.
        • Whittaker E.
        • Sullivan L.
        • et al.
        Effect of restricting dietary protein on the progression of renal failure in patients with insulin-dependent diabetes mellitus.
        N Engl J Med. 1991; 324: 78-84
        • Pedrini M.T.
        • Levey A.S.
        • Lau J.
        • et al.
        The effect of dietary protein restriction on the progression of diabetic and nondiabetic renal diseases.
        Ann Intern Med. 1996; 124: 627-632
        • German J.B.
        • Walzem R.L.
        The health benefits of wine.
        Annu Rev Nutr. 2000; 20: 561-593
        • Lifton L.
        • Scheig R.
        Ethanol-induced hypertriglyceridemia.
        Am J Clin Nutr. 1978; 31: 614-618
        • Valmadrid C.T.
        • Klein R.
        • Moss S.E.
        • et al.
        Alcohol intake and the risk of coronary heart disease mortality in persons with older-onset diabetes mellitus.
        JAMA. 1999; 282: 239-246
        • Solomon C.G.
        • Hu F.B.
        • Stampfer M.J.
        • et al.
        Moderate alcohol consumption and risk of coronary heart disease among women with type 2 diabetes mellitus.
        Circulation. 2000; 102: 494-499
        • Ajani U.A.
        • Hennekens C.H.
        • Spelsberg A.
        • Manson J.E.
        Alcohol consumption and risk of type 2 diabetes mellitus among US male physicians.
        Arch Intern Med. 2000; 160: 1025-1030
        • Clark D.O.
        Physical activity efficacy and effectiveness among older adults and minorities.
        Diabetes Care. 1997; 20: 1176-1182
        • Castaneda C.
        • Layne J.E.
        • Munoz-Orians L.
        • et al.
        A randomized controlled trial of resistance exercise training to improve glycemic control in older adults with type 2 diabetes.
        Diabetes Care. 2002; 25: 2335-2341
        • Haffner S.M.
        • Mykkanen L.
        • Festa A.
        • et al.
        Insulin-resistant prediabetic subjects have more atherogenic risk factors than insulin-sensitive prediabetic subjects.
        Circulation. 2000; 101: 975-980
        • American Diabetes Association
        Diabetes mellitus and exercise.
        Diabetes Care. 2002; 25: S64-S68
        • McAuley K.A.
        • Williams S.M.
        • Mann J.I.
        • et al.
        Intensive lifestyle changes are necessary to improve insulin sensitivity.
        Diabetes Care. 2002; 25: 445-452
        • Brandenburg S.L.
        • Reusch J.E.
        • Bauer T.A.
        • et al.
        Effects of exercise training on oxygen uptake kinetic responses in women with type 2 diabetes.
        Diabetes Care. 1999; 22: 1640-1646
        • Verity L.S.
        • Ismail A.H.
        Effects of exercise on cardiovascular disease risk in women with NIDDM.
        Diabetes Res Clin Pract. 1989; 6: 27-35
        • Walker K.Z.
        • Piers L.S.
        • Putt R.S.
        • et al.
        Effects of regular walking on cardiovascular risk factors and body composition in normoglycemic women and women with type 2 diabetes.
        Diabetes Care. 1999; 22: 555-561
        • Knowler W.C.
        • Barrett-Connor E.
        • Fowler S.E.
        • et al.
        Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.
        N Engl J Med. 2002; 346: 393-403
        • Torjesen P.A.
        • Birkeland K.I.
        • Anderssen S.A.
        • et al.
        Lifestyle changes may reverse development of the insulin resistance syndrome.
        Diabetes Care. 1997; 20: 26-31
        • Nelson K.M.
        • Reiber G.
        • Boyko E.J.
        Diet and exercise among adults with type 2 diabetes.
        Diabetes Care. 2002; 25: 1722-1728
        • Gregg E.W.
        • Beckles G.L.
        • Williamson D.F.
        • et al.
        Diabetes and physical disability among older U.S. adults.
        Diabetes Care. 2000; 23: 1272-1277
        • Serrano-Rios M.
        • Melchionda N.
        • Moreno-Carretero E.
        Role of sibutramine in the treatment of obese type 2 diabetic patients receiving sulphonylurea therapy.
        Diabet Med. 2002; 19: 119-124
        • Gokcel A.
        • Karakose H.
        • Ertorer E.M.
        • et al.
        Effects of sibutramine in obese female subjects with type 2 diabetes and poor blood glucose control.
        Diabetes Care. 2001; 24: 1957-1960
        • McNulty S.J.
        • Ur E.
        • Williams G.
        A randomized trial of sibutramine in the management of obese type 2 diabetic patients treated with metformin.
        Diabetes Care. 2003; 26: 125-131
        • Hollander P.A.
        • Elbein S.C.
        • Hirsch I.B.
        • et al.
        Role of orlistat in the treatment of obese patients with type 2 diabetes.
        Diabetes Care. 1998; 21: 1288-1294
        • McNeely W.
        • Goa K.L.
        Sibutramine.
        Drugs. 1998; 56: 1093-1124
        • Haire-Joshu D.
        • Glasgow R.E.
        • Tibbs T.L.
        Smoking and diabetes.
        Diabetes Care. 1999; 22: 1887-1898
        • Hanefeld M.
        • Fischer S.
        • Julius U.
        • et al.
        Risk factors for myocardial infarction and death in newly detected NIDDM.
        Diabetologia. 1996; 39: 1577-1583
        • Sawicki P.T.
        • Didjurgeit U.
        • Muhlhauser I.
        • et al.
        Smoking is associated with progression of diabetic nephropathy.
        Diabetes Care. 1994; 17: 126-131
        • Howard G.
        • Wagenknecht L.E.
        • Burke G.L.
        • et al.
        Cigarette smoking and progression of atherosclerosis.
        JAMA. 1998; 279: 119-124
        • Ikeda Y.
        • Suehiro T.
        • Takamatsu K.
        • et al.
        Effect of smoking on the prevalence of albuminuria in Japanese men with non-insulin-dependent diabetes mellitus.
        Diabetes Res Clin Pract. 1997; 36: 57-61
        • Targher G.
        • Alberiche M.
        • Zenere M.B.
        • et al.
        Cigarette smoking and insulin resistance in patients with noninsulin-dependent diabetes mellitus.
        J Clin Endocrinol Metab. 1997; 82: 3619-3624
        • Ferrannini E.
        • Haffner S.M.
        • Mitchell B.D.
        • Stern M.P.
        Hyperinsulinaemia.
        Diabetologia. 1991; 34: 416-422
        • Ford E.S.
        • Malarcher A.M.
        • Herman W.H.
        • Aubert R.E.
        Diabetes mellitus and cigarette smoking.
        Diabetes Care. 1994; 17: 688-692
        • Haire-Joshu D.
        • Heady S.
        • Thomas L.
        • et al.
        Beliefs about smoking and diabetes care.
        Diabetes Educ. 1994; 20: 410-415
        • Gavard J.A.
        • Lustman P.J.
        • Clouse R.E.
        Prevalence of depression in adults with diabetes.
        Diabetes Care. 1993; 16: 1167-1178
        • Rossouw J.E.
        • Anderson G.L.
        • Prentice R.L.
        • et al.
        Risks and benefits of estrogen plus progestin in healthy postmenopausal women.
        JAMA. 2002; 288: 321-333
        • Grady D.
        • Herrington D.
        • Bittner V.
        • et al.
        Cardiovascular disease outcomes during 6.8 years of hormone therapy.
        JAMA. 2002; 288: 49-57
        • The North American Menopause Society
        Amended report from the NAMS Advisory Panel on Postmenopausal Hormone Therapy.
        Menopause. 2003; 10: 6-12
        • The North American Menopause Society
        Effects of menopause and estrogen replacement therapy or hormone replacement therapy in women with diabetes mellitus.
        Menopause. 2000; 7: 87-95
        • Ferrara A.
        • Quesenberry C.P.
        • Karter A.J.
        • et al.
        Current use of unopposed estrogen and estrogen plus progestin and the risk of acute myocardial infarction among women with diabetes.
        Circulation. 2003; 107: 43-48
        • Kanaya A.M.
        • Herrington D.
        • Vittinghoff E.
        • et al.
        Glycemic effects of postmenopausal hormone therapy.
        Ann Intern Med. 2003; 138: 1-9